NR 452 ATI RN COMPREHENSIVE EXIT EXAM

NR 452 ATI RN COMPREHENSIVE EXIT EXAM _2020 – Chamberlain College of Nursing ATI RN COMPREHENSIVE EXIT EXAM Terms in this set (1858) 20 weeks gestation, having urinary frequency u/a & c/s non-pharm relation technique for pain management in labor hypnosis mag sulfate decreased urine output decreased respirations decreased pulmonary edema vthaylproroidicmaecdid lwiveeigr hfutnloctsison effectiveness pt DNR-CC & family asking questions related to. therapeutic communication: THERAPEUTIC RESPONSE What did the dr tell you? delegating to AP about skeletal traction: NEEDS MORE AP places weight on bed TEACHING daughter feeling guilty about admitting parent into long-term facility: THERAPEUTIC RESPONSE rephrase what daughter is feeling pt gets bad dx, & asks you not to tell her spouse:YOUR RESPONSE you have a right to privacy baby in contact precautions in a private room, what would you do to save hospital $? how does a nurse properly manage her time mid-shift? bring formula prn reevaluates goals dementia pt @ ER, w/marks on coccyx & wrist, suspected abuse. what do you do? ask pt. INTERVIEW HIM psych pt yelling in front of group. very agitated, what do you do? isolate pt charge nurse scheduling resolution between nurses nurse listens to both sides pt refuses last minute for a procedure he already consented for okay to stop procedure bwarobnygwo/cslteofmt lyipcare uchnatinegainrmgse&vepryedrfaoyr maRyOleMad to skin irritation telemetry is used for check for dysrythmia EMaarglyndeesicuemlesrual tfiaotnes h(seealedcct oamll)pcraelscsiiuomnsgluconate, stop infusion, UO less than interventions 30, RR less than 12, decreased reflexes Thoracentesis causes pneumothorax expected finding not friction rub; tracheal deviation DBaAbSyHwditihetreflux isnmcarella, sferefqrueitn, vt emgeeatlasb, ltehsic, kaenndfloorwmufalat dwaitirhy;rikc,emcge,recal, HOB 30 PUrreineeclfaremqpuseianc y in purionteeisneunrsiaitivity test pregnancy AWChEatindhoibyitoourshea r when creosuognhance you palpate abdomen Pregnant non- pharmacological pain management aromatherapy, breathing techniques, imagery, music, use of focal points, subdued lighting Complication of conscious sedation with RR 6 stop infusion or give something Electrolytes Na - 136-145 K - 3.5-5 Trough Levels Can meds be administered through blood tubing? show the lowest concentration or residual level, usually obtained within 15 minutes before next dose. Do not administer until confirmed. NO. Never administer meds through tubing being used for blood administration Complications associated with IV infusion infiltration, extravasation, phlebitis, thrombophlebitis, hematoma, venous spasm Preventing Extravasation know vesicant potential before giving medication hypertoTnPiNc solution, contains dextrose, proteins, electrolytes, minerals, trace elements, and insulin prescribed, adminis PICC line, subclavian, or internal jugular vein Care for TPN Complications of central venous catheters Pneumothorax during insertion Air Embolism verify with another nurse, use infusion pump, monitor daily weights, I & O, fluid balance, serum glucose q4 to 6 hrs, infection, change dressing q48 to 72 hrs, change tubing and fluid q24 hours, if TPN is unavailable, administer dextrose 10% in water to prevent hypoglycemia pneumothorax during insertion, air embolism, lumen occlusion, bloodstream infection use ultrasound to locate veins, avoid subclavian insertion when possible, treat with O2, assist with chest tube insertion have client lie flat when changing administration set or needleless connectors, ask client to perform Valsava maneuver, treat by placing client in left lateral trendelenberg, and O2 Bloodstream Infection maintain sterile technique, treat by changing entire infusion system, notify MD, obtain cultures, and administer antibiotics Antidote for Cuyaranriede emdertohpyhleonneiubmlu, etensilon Poisoning Lovenox phenytoin 10 to 20 mcg/ml DIPINE calcium channel blockers, amlodipine, nifedipine anti hypertensives ACE inhibitors (angiotensin converting enzyme) assess weight, VS, hydration, ortho BP, renal function, coagulation, educate to take same time each day, avoid hot tubs and saunas, do not discontinue abruptly block the conversion of angiotensin 1 to angiotensin 2 ACE inhibitors and ARBs ACE inhibitors and ARBs side effects ACE inhibitors and ARBs nursing interventions Calcium Channel Blockers for HTN, heart failure, MI, and diabetic nephropathy, monitor potassium, use with caution if diuretic therapy is in use persistent non productive cough with ACE inhibitors, angio edema, hypotension, contra for 2nd and 3rd trimester in pregnancy captopril should be taken 1 hr before meals, monitor BP, monitor for angio edema and promptly administer epinephrine 0.5 ml of 1:1000 solution sub q slows movement of calcium into smooth muscle cells, resulting in arterial dilation and decreased BP, examples are nifedipine/adalat/procardia, verapamil/calan, dilitiazem/cardizem, amlodipine/norvasc Calcium Channel Blockers Precautions use cautiously in clients taking digoxin and beta blockers, contra for client who have heart failure, heart block, or bradycardia, avoid grapefruit juice (toxic) Calcium Channel Blockers nursing interventions do not crush or chew sustained release tablets, administer IV injection over 2 to 3 mins, slowly taper dose if discontinuing, monitor HR and BP Alpha Adrenergic Blockers (symphatholytics) selectively inhibit alpha, adrenergic receptors, resulting in peripheral arterial and venous dilation that lowers BP, esamples are Alpha Adrenergic Blockers (symphatholytics) Use for primary HTN, cardura may be used in treatment of BPH Alpha Adrenergic increased risk of hypotension and syncope if given with Blockers (symphatholytics) Precautions other anti hypertensives, beta blockers, or diuretics, NSAIDs may decrease effect of prazosin Alpha Adrenergic Blockers (symphatholytics) side effects dizziness, fainting Alpha Adrenergic monitor HR and BP, take meds at bed time to minimize Blockers effects of hypotension, advise to notify prescriber (symphatholytics) immediately about adverse reactions, consult prescriber nursing interventions before taking any OTC meds. case mgr arranges for transportation to health care appts w/mental health Do not increase this if pt has COPD O2 exaserbation narrow QRS complex, irregular 170 bpm, no p waves a fib blowing bubbles to make the "hurt go away" is an example of what? nonpharm visualization for pain mgmt w/kids If client is disorientated and combative during the night, what should Rn do? move client closer to Rn station HUsAeisveandtvreorgsleute efafel csit eof? foluboexsetine, hypotension too with these patients for IM position client who is at risk for pressure ulcer at this level 30 degree lateral position in bed Have pt lie on this side during gastric levage for NG tube left-prevents aspiration Diaphram should be removed how long after intercourse? 6 hrs or more 6-8 wet diapers a day indicates? effective breastfeeding Report findings for pt rigid, board like abdomen post ruptured appendix absent bowel sounds 48 hr ago elevated temp elevated wbc (could be indication of peritonitis) correct response? legal doculimvinengtwthillat expresses client's wishes regarding medical treatment in the event the client becomes incapacitat mechanical ventilation, and feeding by artificial means. durable power of attorney enables patient (called the "principal" in the power of attorney document) to appoint an "agent," such as a trusted relative or friend, to handle healthcare decisions on behalf of patient. supporting pts. by ensuring that theyaadrveopcraocpyerly informed, that their rights are respected, and that they are receivin Nurses are the pts. voice when healthcare system is not acting in pt. best interest. delegating supervising case management The process of transferring authority and responsibility to another team member to complete a task while retaining accountability. Process of directing monitoring and evaluating performance of tasks by another member of the health care team. a methodology for moving a patient through the healthcare system while streamlining costs and maintaining quality, Explore resources available to assist with the pt. in achieving or maintaining independence. limb) Access effective ness of pt. breathin g(apnea, depresse d, respirato ry rate, Intervene as appropriate(repositio n, administer narcan). Identify circulation concern (hypotensio n ,dysrhythmi a, inadequate cardiac output, compartment syndrome) identify ways to minimize or reverse circulatory alteration). Access for current evolving disability (neurological deficits stroke evolution) Implement actions to slow down disability. Be informed about all aspects of care and take an active role in decision making process. Accept refuse or request a modification to a plan of care. Receive care that is delivered by a competent individual. prioritize interventions for a pt. in shock over interventions for a pt. with a localized limb injury. Care of pts. with new injuries/illness( confusion, chest pain) over acute exacerbation of a previous illness, over the care over a pt. with a long-term chronic illness. prioritize administration of medication to a pt. experiencing acute pain over a pt. ambulating and at risk for thrombophlebitis. Hypoglycemia risk POST TERM, IUGR, ASPHYXIA, COLD STRESS, factors for Newborns, Blood glucose 40 in term newborn, 25 in preterm newborn Maternal diabetes, Gestational hypertension, Tocolytic therapy, Prematurity, LGA, SGA, Perinatal hypoxia, Infection, Hypothermia Prioritizing care in clients with hyperthyroidism Alternate periods of activity with rest provide calm environment access mental status increased calories and protein monitor intake and output, wt pt. e protection for pt. with exophthalmos y report a degree of 1 or more to MD e prepare for thyroidectomy if meds become unresponsive. Pt. education r/t report fever, sore throat, or bruising to md hyperthyroidism medications, methimazole (tapazole) and (PTU) propylthiouracil. These inhibit the production of thyroid hormone. report any jaundice or dark urine follow md instructions about daily intake of iodine. Risk Factors of Diabetes Dilantin (phenytoin) being African American, Hispanic, or Asian obesity and fat distribution, inactivity, family history, race, age, pre-diabetes, Overweight, family hx, ethnicity, HTN, gestational diabetes, age, viruses, lifestyle, disease of pancreas. Anticonvulsant Seizures, therapeutic levels are determined by blood test. Meds should be taken at the same everyday. Some antieplitic cause overgrowth of the gums, routine oral hygiene. NO ORAL CONTRACEPTIVES OR COUMADIN. Seclusion/ restraints In emergency situation where there is immediate danger to the pt. or others, the nurse may place the pt. in restraints, nurse must maintain prescri ption as soon as possible usually within 1 hour. Nsgassess skin integrity, offer food and fluid, provide hygiene and elimination, vss, rom q2hr. quick release knots to bed frame. Postpartum Assess fundus for height firmness and position. If boggy hemorrhage/ postpartum disorders appropriate assessment. massage fundus to increase muscle contraction. Assess lochia for color, quantity, and clots. Assess for signs of bleeding from lacerations, episiotomy site, or hematomas. Assess for bladder distention, may need to insert urinary catheter to assess kidney function. Pitocin, methergine, IV fluids. cultural/spiritual nursing care, use of a interpreter Dietary guidelines for celiac disease Facility approved interpreter, don't designate the family, or a non designated employee. Inform the interpreter the type of questions that will be answered. Allow time for family and interpreter to be introduced. Direct the questions toward family/pt. not interpreter. Following the interview ask the interpreter if they have any thoughts about pt. verbal or non verbal. children-s/s diarrhea, steatorrhea, anemia abdominal distention, impaired growth, lack of appetite and fatigue. Adults- diarrhea, abdominal pain, bloating, anemia, steatorrhea, and osteomalacia. Dietary Foods that are gluten free-milk, cheese, rice, corn, eggs, potatoes, fruit, veg, fresh poultry, meats, fish, dried beans. Gravy mixes sauces,cold cuts, and soups, have gluten. Parkinson client safety Nephrotic Syndrome dietary modifications prevention of uric acid stones Pt. teaching about self blood glucose monitoring Encourage exercise (yoga), assistive devices, rom, teach pt. to stop when walking to slow down and reduce speed. pace activities by providing rest periods. assist with adls. D/T protein loss, you will need adequate amount of protein and low sodium. Protein-0.7 to 1.0g/kg/day. Soy based proteins, Low sodium g per day. Carbohydrates, trans fat and cholesterol is limited, and total fat should be less than 30% per day, provide multi vitamin supplements. Increase fluid consumption ml at least preferably h20, at night because that's when urine is most concentrated. Foods high in oxlate such as spinach,rhubarb, beets, nuts, chocolate, tea, wheat bran, and strawberries., Avoid mega doses of vitamin c, and limit foods high in purine lean meats, organ meats, whole grains and legumes. Check the accuracy of the strips with the solution use the correct code number in the meter to match strip. store strips in closed container adequate amount of blood proper hand hygiene fresh lancets avoid sharing keep record of blood sugars the calories and exercise taken in. food and other events may alter blood glucose metabolism such as activity or illness. Assessment findings for increased intracranial pressure. Deep Vein thrombosis Interventions Severe HA,deteriorating loc, restlessness, irritiability, dilated pinpoint pupils, asymmetric pupils, slow to react or non reactive, alteration with breathing patterns, cheyne stokes respirations, hyperventilation, apnea, deteriation in motor function, abnormal posturing, decerebrate, decorticate, or flaccidity, cushing reflex, htn, widening pulse pressure, and bradycardia, csf leakage, halo sign, seizures,. Encourage pt. to rest Facilitate bed rest and elevation of extremity donot massage extremity thigh high compression stockings monitor APTT, and platelet count. right evaluation/supervison providing cost effective care using all levels of personnel to fullest when making assignments. providing necessary equipment and charging the pt. Returning uncontaminated or unused equipment to appropriate dept. for credit. Using equipment properly to prevent wastage providing training to staff unfamiliar with equipment, Returning equipment to proper dept. as soon as its no longer needed. Psychotic disorders assessment findings Adolescent nutritional needs Newborn withdrawl from opioids medications Alcohol withdrawl Contraindications to oral contraceptives Hallucinations, deluisons, alterations in speech, bizarre behavior are positive signs of schizophrenia. Negative signs-affect or flat facial expression, alogia- poverty of thought of speech, Anergia-lack of energy, anhedonia- lack of pleasure or joy, avolition- lack of motivation in activities and hygiene 00 2000 cal for female and 4000 cal for male. They need a adequate diet in folate, vit a&e, iron, zinc, mag, cal and fiber. opiate withdrawl, can last 2 to 3 weeks rapid mood changes, hypersensitivity to noise and external stimuli, dehydration, and poor weight gain. nabdominal cramping, vomiting, tremors, restlessness, inability to sleep, increased heart rate, hallucinations, illusions, anxiety, increased blood pressure, respiratory rate, temp, and tonic clonic seizures. May occur 2-3 days after cessation of alcohol, and may last for 2-3 days, *THIS IS A MEDICAL EMERGENCY. severe disorientation, severe htn, psychotic symptoms, cardiac dysthymias, delirium. Meds- valium, Ativan, carbamazepine (tegretrol) seizures, clonidine (catapres) Librium (chlordiazepoxide) Hx of blood clots, stroke, cardiac problems, breast or estrogen related cancers, pregnancy or smoking if over 35, are advised not to take oral contraceptives. Oral contraceptives decreases its effectiveness when taking meds that effect liver enzymes, such as ATB's, and anticonvulsants. Access to medical records Discharge teaching regarding circumsion Stroke priority assess findings Clients have a right to read their on records. Nurses may not photocopy any part of mar. Communication should only take place in a private setting. Shred any printed written pt. info after pt. care or use. A tub bath should not be given unti healed Notify md of redness, discharge, swelling, strong odor, tenderness, decrease in urination, or excessive crying, will heal completely in 2 weeks. Give Tylenol for first 24 to 48 hours. Assess for bleeding every 15 min for the first hour, then every hour for at least 12 hour, then the 1st voiding. Expressive and receptive aphasia, agnosia, (unable to recognize objects), alexia (difficulty to reading), a graphic (writing difficulty), hemiplegia,(paralysis), or hemiparesis (weakness), slow behavior, depression, anger, visual changes(hemianopsia). Stimulant withdrawl (cocaine) Withdrawl stimulant (tobacco) Occurs within1 hour to several days, restlessness anxiety insomnia increased appetite difficulty concentrating anger depressed mood, High calorie foods for energy Encourage rest periods. Drink plenty of fluids to liquidfy mucous, and promote hydration. IV Therapy documenting complications. Require notification of MD, and documentation, all IV infusions should be restarted with new tubing and catheters. Infiltration-Inpflaliltorartiaonnd local swelling at site, slowed rate of infusion, treatment-stop and remove catheter, elevate extrem compress. Restart proximal to site or another extremity. Ecchymosis removal. Use warm compress and elevate after bleeding has subsided. Prevention- minimize tourniquet time, prescribed. Prevention- monitor I&O. Post arthroplasty Use elevated seat, or raised toilet seat. Use straight chairs with arms Use abduction pillow, or pillow if prescribed, b/w the pt. legs while in bed, and with turning, if restless or in a altered mental state. Externally rotate pt. toes. Do not do, cross legs, avoid low chairs, avoid flex ion of hips at 90 degrees, do not internally rotate the toes. Crutch walking Insertion of a urinary catheter Ototoxic medications Do not alter after crutches after fitting Support body weight at the hand grips, with elbows flexed at 30 degrees, position the crutches on the unaffected side when sitting or rising from a chair. Usually 8-10 French for kids, 12-14 for women, and 16-18 for men. Use silicon or Teflon if pt. has latex allergies. Explain procedure, a closed intermittent irrigation. if pt. reports fullness in bladder area, check for kinks in tubing or sediment, may need irrigated, make sure bag is below bladder. Multiple antibiotics, gentamicin, amikacin, metronidazole(flagyl), lasix, NSAIDs, chemotherapeutic agents. Urethral discharge, yellowish green vaginal Nursing care of a pt. who is pregnant and has gonorrhea Esophageal discharge, reddened vulva and vaginal walls. Ceftriaxone (rocephin) and azithromycin (Zithromax) pro for gonorrhea, take entire prescription, repeat culture, and educate on safe sex practices. prescription for a pt. with esophageal varices Interventions for dementia Interventions for prolapse cord Dumping syndrome S/S No selective beta blockers, propranolol (inderal), are prescribed to decrease heart rate, and reduce hepatic pressure. Vasoconstrict ors IV terlipressin and somatostatin increase portal inflow. And vasopressin (desmopressi n) and ortreotide ( sandostatin) are avoided d/t multiple adverse reactions. Call for assistance ASAP, notify MD, use a sterile gloved hand, insert 2 fingers in vagina, and apply finger pressure on on either side of the cord, to fetal presenting part to elevate it off cord, reposition knee chest position, or trendelenburg, or side lying with a rolled towel under the pt. right or left hip, to relieve pressure on cord. Apply a warm saline soaked sterile towel to cord to prevent from drying. Provide cont electronic monitoring of FHR for variable decels. O2 at 8-10 liters, IV access, prepare for c- section, educate and inform pt. on interventions. Provide clocks and memory aids, photographs, memorabilia, seasonal decorations, familiar objects, orient if necessary. Daily routine, allow for safe pacing and wandering. Assign room closets to nurses station, well lit environment. Restraints as a last resort, COver or remove mirrors to reduce anxiety and frustration. Encourage pt. to talk about good times, break instructions and activities into short timeframes. Fullness, faintness, diaphoresis, tachycardia, palpitations, hypotension, nausea, abdominal distinction, cramping, diarrhea, weakness, and syncope. Psychotic disorders long term adverse reactions New onset of diabetes, or loss of glucose control in pets. With diabetes, weight gain, increased cholesterol with HTN, orthostatic hypotension, anticholinergic effects such as urinary hesitancy or retention, and dry mouth. agitation, dizziness, sedation, and sleep disruption, mild eps such as tremor. Treating xerostomia following radiation Post procedure following a throcentesis Avoid spicy, salty, acidic foods, hot foods may not be tolerated. Gently wash over irradiated skin with mild soap and water, pat dry. Dips of h20, and candies to prevent dry mouth. Apply dressing and assess for bleeding, or drainage, monitor vs, and resp hourly. Auscultation lungs for reduced breath sounds, encourage deep breathing to assist with lung expansion. CHESTXRAY post procedure. Addison's & Cushings Addison's = down down down up down Cushings= up up up down up hypo/hypernatremia, hypo/hypertension, blood volume, hypo/hyperkalemia, hypo/hyperglycemia Droplet precautions Contact precaution spiderman! sepsis, scarlet fever, streptococcal pharyngitis, parvovirus, pneumonia, pertussis, influenza, diptheria, epiglottitis, rubella, mumps, meningitis, mycoplasma or meningeal pneumonia, adeNovirus (Private room and mask) MRS WHISE protect visitors & caregivers when 3 ft of the pt. Multidrug-resistant organisms RSV, Shigella, Wound infections, Herpes simplex, Impetigo, Scabies, Enteric diseases caused by micro-organisms (C diff), Gloves and gowns worn by the caregivers and visitors Disposal of infectious dressing material into a single, nonporous bag without touching the outside of the bag PMGG= Private room/ share same illness, mask, gown and gloves Air or Pulmonary Embolism Woman in labor (un- reassuring FHR) S/S chest pain, dyspnea, tachycardia, pale/cyanotic, sense of impending doom. (turn pt to LEFT side and LOWER the head of bed.) (late decels, decreased variability, fetal bradycardia, etc) Turn pt on Left side, give O2, stop pitocin, Increase IV fluids! After lumbar puncture and oil based myelogram pt is flat SUPINE (prevent headache and leaking of CSF) After total hip replacement don't sleep on side of surgery, don't flex hip more than 45- 60 degress, don't elevate Head Of Bed more than 45 degrees. Maintain hip abduction by separating thighs with pillows. To prevent dumping syndrome (post operative ulcer/stomach surgeries) eat in reclining position. Lie down after meals for 20-30 min. also restrict fluids during meals, low CHO and fiber diet. small, frequent meals. Autonomic Dysreflexia/Hyperreflex ia S/S pounding headache, profuse sweating, nasal congestion, chills, bradycardia, hypertension. Place client in sitting position (elevate HOB) FIRST! HPeeraitdonInejaulryDialysis etulernvapttefHroOmBs3id0edteogsriedesBtEoFdOeRcErecahs ecIkCinPg for kinks in (when outflow is inadequate) tubing Hypo-parathyroid Hyper-parathyroid CATS---Convulsions, Arrhythmias, Tetany, Spasms, Stridor. (decreased calcium) give high calcium, low phosphorus diet fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium) give a low calcium high phosphorous diet Hyperkalemia MURDER Muscle weakness, Urine (olig, anuria) Resp depression, decreased cardiac contractility, ECG changes, reflexes Hypercalcemia muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon reflexes, shallow respirations, emergency! Pheochromocytoma hypersecretion of epi/norepi. persistent HTN, increased HR, hyperglycemia, diaphoresis, tremor, pounding HA; avoid stress, frequent bathing and rest breaks, avoid cold and stimulating foods (surgery to remove tumor) Autonomic Dysreflexia FHR patterns for OB what to check with pregnancy Position of the baby by fetal heart sounds (potentially life threatening emergency!) HOB elevate 90 degrees, loosen constrictive clothing, assess for full bladder or bowel impaction, (trigger) administer antihypertensives (may cause stroke, MI, seizure) Think VEAL CHOP! V-variable decels; C- cord compression caused E-early decels; H- head compression caused A-accels; O-okay, no problem L- late decels; P- placental insufficiency, can't fill Never check the monitor or machine as a first action. Always assess the patient first. Ex.. listen to fetal heart tones with stethoscope. Posterior --heard at sides Anterior---midline by unbilicus and side Breech- high up in the fundus near High alarm-- Obstructio n due to secretions, kink, pt cough etc Low alarm--Disconnection, leak, etc NCLEX answer tips choose assessment first! (assess, collect, auscultate, monitor, palpate) only choose intervention in an emergency or stress situation. If the answer has an absolute, discard it. Give priority to the answers that deal with the patient's body, not machines, or equipment. When pt is in distress. medication administration is rarely a good choice COPD and O2 with COPD baroreceptors that detect CO2 level are destroyed, therefore, O2 must be low because high O2 concentration takes away the pt's stimulation to breathe. Preload/Afterload Preload affects the amount of blood going into Right ventricle. Afterload is the systemic resistance after leaving the heart. Unstable Angina not relieved by nitro PVC's can turn into V fib. 1 tsp 5 mL 1 oz 30 mL 1 cup 8 oz 1 quart 2 pints 1 pint 2 cups Myasthenia gravis decrease in receptor sites for acetylcholine. weakness observed in muscles, eyes mastication and pharyngeal musles. watch for aspiration. burns rule of head and neck 9% Nines each upper ext 9% each lower ext 9% front trunk 18% back trunk 18% genitalia 1% pathological jaundice before 24 hours (lasts 7 days) occurs: after 24 hours physiological jaundice occurs: five interventions for safety psych patients setting limits establish trusting relationship meds least restrictive methods/environment delusions TAhlzohraeziminer'asnd Haldol c6a0n%coafuaslel dEePmS entias, chronic, progressive degenerative cognitive disorder. Cranial nerves S=sensory M=motor B=both Oh (Olfactory I) Some Oh (Optic II ) Say Oh (Oculomotor III) Marry To (trochlear IV) Money Touch (trigeminal V) But And (Abducens VI ) My Feel (facial VII) Brother A (auditory VIII) Says Girl's (glossopharyngeal IX) Big Vagina (vagus X) Bras And (accessory XI) Matter Hymen (Hypoglossal XII) More Developmental 2-3 months: turns head side to side 4-5 months: grasps, switch and roll 6-7 months: sit at 6 and waves bye bye 8-9 months: stands straight at 8 10-11 months: belly to butt 12-13 months: 12 and up, drink from a cup Dumping syndrome Disseminated herpes zoster localized herpes zoster increase fat and protein, small frequent meals, lie down after meal to decrease peristalsis. Wait 1 hr after meals to drink Disseminated herpes=airborne precautions Localized herpes= contact precautions. A nurse with localized may take care of patients as long as pts are not immunosuppressed and the lesions must be covered! Weighted NI (naso intestinal tubes) Must float from stomach to intestine. Don't tape right away after placement. May leave coiled next to pt on HOB. Position pt on RIGHT to facilitate movement through pyloris pancreatitis pts put them in fetal position, NPO, gut rest, Prepare anticubital site for PICC, they are probably going to get TPN/Lipids Peritoneal dialysis Its ok to have abd cramps, blood tinged outflow and leaking around site if the cath (tenkoff) was placed in the last 1-2 weeks. Cloudy outflow is never ok Latex allergies assess for allergies to bananas, apricots, cherries, grapes, kiwis, passion fruit, avocados, chestnuts, tomatoes and peaches Transesophageal fistula esophagus doesn't fully develop. This is a surgical emergency (3 signs in newborn: choking, coughing, cyanosis) codes for pt care Red- unstable, ie.. occluded airway, actively bleeding...see first Yellow--stable, can wait up to an hour for treatment Green--stable can wait even longer to be seen---walking wounded Blac k-- unst able , pro babl y will not mak e it, nee d com fort car e DOA--dead on arrival othryarnogide mtaegdinsipdseycehffectsinseommenrigae. nbtopdsyymchetabolism increases Munchausen syndrome vs munchausen by proxy Munchausen will self inflict injury or illness to fabricate symptoms of physical or mental illness to receive medical care or hospitalization. by proxy mother or other care taker fabricates illness in child multiple sclerosis motor s/s limb weakness, paralysis, slow speech. sensory s/s numbness, tingling, tinnitis cerebral s/s nystagmus, atazia, dysphagia, dysarthia hungtington's 50% genetic autosomal dominanat disorder.. s/s uncontrolled muscle movements of face, limbs and body. no cure Thoracentesis: Cardiac cath position pt on side or over bed table. no more than 1000 cc removed at a time. Listen for bilateral breath sounds, V.S, check leakage, sterile dressing NPO 8-12 hours. empty bladder, pulses, tell pt may feel heat, palpitations or desire to cough with injection of dye. Post: V.S.--keep leg straight. bedrest for 6-8 hr Myelogram Liver biopsy depressants and stimulants withheld 48 hours prior. Table moved to various positions during test. Post--neuro assessment q2-4 hours, water soluble HOB UP. oil soluble HOB down. oralanalgesics for HA. No po fluids. assess for distended bladder. Inspect site administer Vitamin K, NPO morning of exam 6 hrs. Give sedative. Teach pt to expect to be asked to hold breath for 5-10 sec. supide position, lateral with upper arms elevated. Post--position on RIGHT side. frequent VS. report severe ab pain STAT. no heavy lifting 1 wk DKA kussmal's breathing (deep rapid) intraosseous infusion often used in peds when venous access can't be obtained. hand drilled through tibia where cryatalloids, colloids, blood products and meds are administered into the marrow. one med that CANNOT be administered IO is isoproterenol, a beta agonist. ventriculoperitoneal shunt watch for abdominal distention. watch for s/s of ICP such as high pitch cry, irritability and bulging fontanels. In a toddler watch for loss of appetite and headache. After shunt is placed bed position is FLAT so fluid doesn't reduce too rapidly. If presenting s/s of ICP then raise the HOB 15- 30 degrees cryptorchidism undescended testicles! risk factor for testicular cancer later in life. Teach self exam for boys around age 12--most cases occur in adolescence positioning for pneumonia lay on affected side, this will splint and reduce pain. However, if you are trying to reduce congestion, the sick lung goes up! (like when you have a stuffy nose and you lay with that side up, it clears!) normal PCWC (pulmonary capillary wedge pressure) is 8-13 readings 18-20 are considered high Sucking stab wound cover wound and tape on 3 sides to allow air to escape. If you cover and occlude it--it could turn into a closed pneumo or tension pneumo! Hirschprung's Intussusception diagnosed with rectal biopsy. S/S infant-failure to pass meconium and later the classic ribbon-like/foul smelling stools Common in kids with CF. Obstruction may cause fecal emesis, current jelly stools. enema--- resolution=bowel movements up stairs with crutches? down stairs with crutches? good leg first followed by crutches(good girls go to heaven) crutches with the injured leg followed by the good leg. Defamation is a false communication or careless disregard for the truth that causes damage to someone's reputation. in writing(Libel) or Verbally(Slander) quad cane place of unaffected side of body place it 6-12 in in front of the body before walking steps forward with affected leg first b ing the unaffected leg as well, bringing the foot past the r cane Fluoxetine (Prozac) asthma kid report tremors, agitation, confusion, anxiety, hallucinations=serotonin syndrome (risk in the first 2-72 hrs after given first time); client will stop the meds; weight gain/diabetes/ hyperglicemia should participate in sports, inhaler prior to sports, stay inside when cold, use peak flow meter every day same time, annual influenta vaccine important Dexamethasone for RA intermittent enteral tube feeding diarrhea after each feeding AE: hyperglycemia, glicosuria, adrenal insufficiency, osteoporosis, infection, myopathy, fluid and electrolyte imbalance, cataracts, pud intervention: reduce rate of feeding or switch to continuous feeding breast CA signs after CVA-possible problems swallowing and risk for aspiration report: dumplin g of the tissue=ti ssue is retracted, silver striae-expected, new nipple inversion- report, if pt had it ever since menarche-ok, visible symmetrical venous pattern-ok, not symmetrical-not ok chin to chest will help modified 3 point crutch gait-going upstairs order stand and bear weight on the unaffected leg transfer body weight to the crutches advance the unaffected leg between the crutches shift leg from the crutches to the unaffected leg alling crutches on the stairs NG tube verify placement if new-xray if not new, just to verify before new feeding-aspirate contents of the tube and verify PH (1-4) PAD (peripheral arterial disease) lubricate skin of feet with lotion, don't use heating pads, trim toenails straight, dont elevate feet above level of heart AIDS no exposure to soil toothbrush in dishw =no gardening; dont use pepper; dont eat food that has been sitting out for mo asher weekly re tha Cyclophosphomide (Cytoxan) for a toddler for neuroblastoma increase fluids to prevent hemorrhagic cystitis, give early in the day Post partum client risk of DVT-unilateral leg pain, calf tenderness, leg swelling intravenous pylogram laxative right before procedure, clear liquids or nothing after midnight, check for allergies for seafood, milk, eggs, chocolate; encourage fluids after to remove dye sterile field/ aseptic technique maintain things within line of vision, 1 in border is contaminated, nothing bellow waist, dont tie dr's gown in the BACK-thats contaminated, dont turn your back on the field, tight hands together above waist Suctioning-pt with tracheostomy following a laryngectomy pass catheter no more than three times, cough is normal- expected, surgical Not medical asepsis used, resistance- withdraw catheter 1-2 cm crutches going up the stairs advance unaffected leg to the stairs, place the put weight on good leg and cruthes, weight on unaffected leg and the crutches, advance affected leg and crutches forward up the stairs Evisceration and dehiscence require emergency treatment. ■ Call for help. ■ Stay with the client. ■ Cover the wound and any protruding organs with sterile towels or dressings soaked with sterile normal saline solution. Do not attempt to reinsert the organs. ■ Position the client supine with the hips and knees bent. ■ Observe for signs of shock. ■ Maintain a calm environment. ■ Keep the client NPO in preparation for returning to surgery. Ulcer s ◯ Stage I - Intact skin with an area of persistent, nonblanchable redness, typically over a bony prominence, that may feel warmer or cooler than the adjacent tissue. The tissue is swollen and has congestion, with possible discomfort at the site. With darker skin tones, the ulcer may appear blue or purple. ◯ Stage II - Partial-thickness skin loss involving the epidermis and the dermis. The ulcer is visible and superficial and may appear as an abrasion, blister, or shallow crater. Edema persists, and the ulcer may become i nfected, possibly with pain and scant drainage. ◯ Stage III - Full-thickness tissue loss with damage to or necrosis of subcutaneous tissue. The ulcer may extend down to, but not through, underlying fascia. The ulcer appears as a deep crater with or without undermining of adjacent tissue and without exposed muscle or bone. Drainage and infection are common. ◯ Stage IV - Full-thickness tissue loss with destruction, tissue necrosis, or damage to muscle, bone, or supporting structures. There may be sinus tracts, deep pockets of infection, tunneling, undermining, eschar (black scab-like material), or slough (tan, yellow, or green scab-like material). ◯ Unstageable - No determination of stage because eschar or slough obscures the wound. postoperative following cleft lip and palate repair prone position to facilitate drainage RDS newborn ■ Tachypnea (respiratory rate greater than 60/min) ■ Nasal flaring ■ Expiratory grunting ■ Retractions ■ Labored breathing with prolonged expiration ■ Fine crackles on auscultation ■ Cyanosis ■ Unresponsiveness, flaccidity, and apnea with decreased breath sounds (manifestations of worsened RDS) phototherapy for high billirubin ■ Maintain an eye mask over the newborn's eyes for protection of corneas and retinas. ■ Keep the newborn undressed with the exception of a male newborn. A surgical mask should be placed (like a bikini) over the genitalia to prevent possible testicular damage from heat and light waves. Be sure to remove the metal strip from the mask to prevent burning. ■ Avoid applying lotions or ointments to the skin because they absorb heat and can cause burns. ■ Remove the newborn from phototherapy every 4 hr, and unmask the newborn's eyes, checking for inflammation or injury. tion the newborn every 2 hr to expose prevent pressure sores. ■ Check the lamp energy with a photometer per facility protocol. ■ Turn off the phototherapy lights before drawing blood for testing. Authoritative Makes decisions for the group. ◻ Motivates by coercion. ◻ Communication occurs down the chain of command. ◻ Work output by staff is usually high - good for crisis situations and bureaucratic settings. ◻ Effective for employees with little or no formal education. Democratic ◻ Includes the group when decisions are made. ◻ Motivates by supporting staff achievements. ◻ Communication occurs up and down the chain of command. ◻ Work output by staff is usually of good quality - good when cooperation and collaboration are necessary Laissez-faire ◻ Makes very few decisions, and does little planning. ◻ Motivation is largely the responsibility of individual staff members. ◻ Communication occurs up and down the chain of command and between group members. ◻ Work output is low unless an informal leader evolves from the group. ◻ Effective with professional employees. Quality Improvement ◯ Outcome, or clinical, indicators reflect desired client outcomes related to the standard under review. ◯ Structure indicators reflect the setting in which care is being provided and the available human and material resources. ◯ Process indicators reflect how client care is provided and are established by policies and procedures (clinical practice guidelines). ◯ Benchmarks are goals that are set to determine at what level the outcome indicators should be met QI eg Cane, left leg is affected While process indicators provide important information about how a procedure is being carried out, an outcome indicator measures whether that procedure is effective in meeting the desired benchmark. For example: the use of incentive spirometers in postoperative clients may be determined to be 92% (process indicator) but the rate of postoperative pneumonia may be determined to be 8% (outcome indicator). If the benchmark is set at 5%, the benchmark for that outcome indicator is not being met and the structure and process variables need to be analyzed to identify potential areas for improvement hold cane on strong side, keep two points support all the time on the ground, place cane 6 to 10 in in front before advancing, advance weak leg first followed by good leg, advance strong lef past the cane CPnaerduimacothaomrpaxonade mtraucffhleadl hdeeavritatsiounnds, pulsus paradoxus, Liver enzymes • Triglycerides 150mg/dL • ALT/SGPT 8-20 units/L • AST/SGOT 5-40 units/L • ALP 42-128 units/L • Total protein 6-8 gm/dL Pancreatic enzymes • Amylase 56-90 IU/L • Lipase 0-110 units/L • Prothrombin time 0.8-1.2 Arterial Blood Gases pH 7.35 -7.45 (ABG) Pa02 80-100 mm Hg PaC02 35-45 mm Hg HCO3 21 - 28 mEq/L Sa O2 95-100% Cl 98-106 Creatinine phosphokinase MB (CK- MB) normal 30-170 units/L *increase 4-6 hrs after MI and remains elevated 24-72hrs Describe the following ECG findings in 1st degree AV block: rhythm rate QRS duration P wave P wave rate P-R interval What type of heart block is associated with a QRS drop? block Describe the following ECG findings in 2nd degree block - Mobitz Type 2: rhythm rate QRS duration P:QRS ratio P wave rate P-R interval Describe the following ECG findings in 3rd degree block (complete AV block): rhythm rate QRS duration P wave P wave rate P-R interval List the 3 basic increased automaticity of pacemaker mechanisms for tachyarrhythmias. Which spontaneous depolarizations is most common? re-entrant circuit (most common) Describe the following ECG findings in sinus tachycardia: rate is less than 150 beats per minute rhythm rate QRS duration P wave P-R interval What phase of the ventricular action potential corresponpdhsase 2 to the ST segment? During which 2 phases of the ventricular action potential do sppohnatsaene3ous depolarizations occur? phase 4 potassium channels A "twisting" polymorphic ventricular tachycardia that is observed in situations where the QT interval has been prolonged torsades de pointes What fatal disorder is associated with torsades de points? ventricular fibrillation List 3 examples of re- Atria tachycardia entrant arrhythmias. atrial flutter atrial fibrillation supraventricular re-entrant tachycardia as in Wolff- Parkinson-White syndrome ventricular tachycardia A 17-year-old boy is referred to a cardiologist by a primary care physician for evaluation of recurrent spells of dizziness. During the episodes, he feels intense anxiety with palpitations and breathlessness. He is asymptomatic in between episodes; There is no h/o chest pain or syncope. Physical examination: No abnormalities detected Lab: EKG: Short PR interval; wide QRS with a slurred upstroke. Blood: Normal; Chest X ray: Normal List 3 ECG findings in Wolff-Parkinson-White syndrome. What is the name of the wide QRS wave with a slurred upstroke seen in Wolff-Parkinson- White syndrome? Wolff-Parkinson-White syndrome short PR interval wide QRS delta wave delta wave - widened QRS signifies pre-excitation Wolff-Parkinson-White syndrome A 46-year-old woman arrived in the ER complaining of sudden onset of palpitations, lightheadedness, and shortness of breath. These symptoms began approximately 2 hours previously. PE: BP 95/70 mm Hg Heart Rate - averages 170 beats/min, regular Rest of her physical examination is unremarkable EKG: abnormal P waves; P-R intervals are within normal limits; normal QRS complexes supraventricular tachycardia How can one use an If the QRS complex is narrow (3 small boxes) - ECG to differentiate SVT. If the QRS complex is wide (3 small boxes) between - VT. supraventricular and ventricular tachycardia? Describe the following ECG findings in supraventricular tachycardia: rhythm rate QRS duration P wave P-R interval List 4 types of atrial tachycardia supraventricular tachycardias. atrial flutter atrial fibrillation AV node reentrant tachycardia atrioventricular reentrant tachycardia Describe the following ECG findings in atrial flutter: rhythm rate QRS duration P wave P wave rate P-R interval A 44-year-old male complains of occasional palpitations, shortness of breath, dizziness and chest discomfort. Physical examination: Pulse: Irregularly irregular JVP: absent "a" waves Heart sounds: variable intensity S1 with occasional S3 Lab: EKG: Variable ventricular rate (90-190); Irregular RR intervals. Blood: CK-MB normal Chest X ray: Normal atrial fibrillation Describe the following ECG findings in ventricular tachycardia: rhythm rate QRS duration P wave Describe the following ECG findings in ventricular fibrillation: rhythm rate QRS duration P wave List 3 possible diagnoses if QRS 120 ms. List 3 possible diagnoses if QRS 120 ms. sinus arrhythmia supraventricular rhythm junctional tachycardia ventricular tachycardia supraventricular rhythm with additional bundle branch block additional accessory AV pathway A patient asks you He can modify his risk for cardiovascular disease by losing about his risk of cardiovascular disease. He is 50-years old and has diabetes, is overweight and smokes cigarettes. You advise him that: weight and not smoking Which of the following is true of the coronary arteries? The coronary arteries begin just above the aortic valve In the event of a coronary artery blockage, the muscle of the heart can receive blood from the: Anastomoses that provide collateral circulation The right atrium receives blood from the systemic circulation and the: Coronary veins The valve between the right atrium and the right ventricle is the: Tricuspid valve Stroke volume depends on preload, afterload, and: Myocardial contractility The most important factor in determining stroke volume inPraeload healthy heart is: An increase in peripheral vascular resistance: Decreases stroke volume The ventricles of the heart are innervated mainly by: Parasympathetic control of the heart is provided by the: The resting membrane potential is determined primarily by the difference between the intracellular potassium ion level and the Sympathetic nerve fibers Vagus nerve Extracellular potassium ion level The sodium-potassium pump functions to move: Potassium ions into the cell and sodium ions out of the cell Phase I of the action potential represents the period of: Early rapid repolarization During the period between action There is excessive sodium in the cell potentials: The dominant pacemaker of the heart under normalSA node conditions is the: You are treating a patient who has a damaged SA node that is no longer pacing the heart. You would expect the patient's heart to: Beat more slowly Which of the following cardiac pacemakers has an intrinsic rate of 40 to 60 beats per AV junction minute? You are treating a 75- year-old woman who has a history of diabetes and atherosclerosis. Her chief complaint is persistent heartburn. You suspect: Jugular vein distention in cardiac patients should be evaluated with the patient positioned: While assessing a patient you identify a carotid bruit. This leads you to believe that the patient: This may be a cardiovascular problem With the head elevated 45 degrees Has atherosclerosis viewing a: Standard ECG paper is divided into 1-mm blocks and moves past the stylus of the ECG at 25 mm per second. Each small block represents: 0.04 second Each small square of graph paper represents mV. 0.1 The PR interval represents the time it takes an electrical impulse to: Be conducted through the atria and the AV node second. While analyzing an ECG you cannot identify a Q wave. This means: The Q wave may not be visible in the lead you are viewing Deep and symmetrically inverted T waves may be indicative of: Cardiac ischemia The part of the ECG tracing that is most important for detecting life-threatening arrhythmias is the: QRS complex The triplicate method of determining heart rate is: When analyzing an ECG tracing, you notice that the rhythm is highly irregular. The best method to calculate the rate is the Accurate when the heart rate is normal and greater than 50 beats per minute Six-second count method While evaluating a 22- year-old female runner who called 911 because she fell and twisted her ankle, you apply an ECG monitor. Her heart rate is 46, P waves are normal and upright, the PR interval is 0.16 second, and the QRS complex looks normal. There is a QRS complex following each P wave. The patient's ECG tracing reflects: While evaluating a 22- year-old female runner who called 911 because she fell and twisted her ankle, you apply an ECG monitor. Her heart rate is 46, P waves are normal and upright, the PR interval is 0.16 second, and the QRS complex looks normal. There is a QRS complex following each P wave. Treatment for this patient's heart rate should include: Sinus bradycardia No treatment at this time Isoproterenol raises the heart rate by functioning as a: Beta agonist ECG analysis reveals that each P wave in the tracing has a different shape. The heart rate is 80 beats per minute. Wandering pacemaker This is called: Which of the following may cause sinus bradycardia? Intrinsic sinus node disease An ECG strip shows a regular rhythm with a QRS complex of 0.08, a rate of 145, a PR interval of 0.12, and one upright P wave before each QRS complex. You suspect that this rhythm is: You are called to evaluate a 64-year-old woman who complains of palpitations, weakness, and dizziness. Her heart rate The ECG tracing shows narrow QRS complexes and no identifiable P waves. This rhythm is most likely: You are called to identifiable P waves. The first recommended treatment for th is evaluate a 64-year-old patient is: woman who complains of palpitations, weakness, and dizziness. Her heart rate is 160 beats per minute, her blood pressure is 118/ 80 and her respiratory rate is 28. The ECG tracing shows narrow QRS complexes and no Valsalva maneuver Which of the followinYou are called to evaluate a 64-year- old woman who complains of palpitations, weakness, and di 28. The ECG tracing shows narrow QRS complexes and no identifiable P waves. Which of the following drugs is a class I ( for this patient? You are called to evaluate a 64-year-old woman who complains of palpitations, weakness, and dizziness. Her heart rate is 160 beats per minute, her blood pressure is 118/ 80 and her respiratory rate is 28. The ECG tracing shows narrow QRS complexes and no identifiable P waves. The patient begins to develop ch pain, and her blood pressure drops to 100/60. The treatment o choice for this patient is now: est f You see an irregular rhythm on the monitor with a rate of 66 to 80, a normal PR interval, and a P wave for every QRS. The rate speeds up and slows down with the patient's respiratory rate. You suspect that this rhythm is: Sinus dysrhythmia You are treating a 70- year-old male patient with atrial fibrillation. The patient's ventricular heart rate is 180 beats per minute, the blood pressure is 90/60, and the patient complains chest pain. The hallmark of atrial fibrillation is: irregular rhythm You are treating a 70- present for more than 48 hours, conversion of this patient's year-old male patient rhythm may lead to: with atrial fibrillation. The patient's ventricular heart rate is 180 beats per minute, the blood pressure is 90/60, and the patient complains of chest pain. You have determined that your atrial fibrillation patient is unstable and requires electrical therapy. You will perform countershock with joules You are treating a 70- year-old male patient with atrial fibrillation. The patient's ventricular heart rate is 180 beats per minute, the blood pressure is 90/60, and the patient complains of chest pain. If this patient's atrial fibrillation has been Synchronized; 100 Release of emboli An ECG strip shows a rhythm with a rate of 45, a QRS of 0.08, and a P wave that appears after thJuenQctiRoSn. Yaol u suspect tha most likely: The intrinsic rate for a ventricular pacemaker is beats per minute. 20 to 40 Your patient has a regular bradycardic rhythm with a rate of 40, no P waves, and a QRS greater than 0.12. This is: Ventricular escape rhythm ay The treatment of choice for a symptomatic ventricular esPcaacpineg rhythm is: Which of the following is true of ventricular tachycardia? Patients with pulseless ventricular tachycardia should be treated as though they have: Ventricular tachycardia is triggered by a PVC Ventricular fibrillation Synchronized cardioversion is acceptable for patients with venIntraiclluclaarses tachycardia: The most common arrhythmia in sudden cardiac arrest is: Ventricular fibrillation Which of the following is an absolute indication for unsynchronized cardioversion? Ventricular fibrillation You are treating a 65- year-old man who is complaining of chest pain and difficulty breathing. On ECG examination, you note that his ventricular heart rate is 56, and there are more P waves than QRS complexes. The PR interval is constant when a QRS follows a P wave. The QRS complexes are normal and narrow.You suspect this patient has what type of heart block? Second-degree type II You are treating a 65- year-old man who is complaining of chest pain and difficulty breathing. On ECG examination, you note that his ventricular heart rate is 56, and there are more P waves than QRS complexes. The PR interval is constant when a QRS follows a P wave. The QRS complexes are normal and narrow. This type of heart block is typically considered to be a: You are treating a 65- year-old man who is complaining of chest pain and difficulty breathing. On ECG examination, you note that his ventricular heart rate is 56, and there are more P waves than QRS complexes. The PR interval is constant when a QRS follows a P wave. The QRS complexes are normal and narrow. The definitive treatment for this patient is: Serious arrhythmia regardless of signs and symptoms You are treating a 65- year-old man who is complaining of chest pain and difficulty breathing. On ECG examination, you note that his ventricular heart rate is 56, and there are more P waves than QRS complexes. The PR interval is constant when a QRS follows a P wave. The QRS complexes are normal and narrow. Prehospital care for this patient consists of: Transvenous pacemaker insertion Transcutaneous pacing You are treating a 65- year-old man who is complaining of chest pain and difficulty breathing. On ECG examination, yo conducted through the: You are treating a 65- year-old man who is complaining of chest pain and difficulty breathing. On ECG examination, yo associated with: Which of the following is a class I intervention for all symptomatic bradycardias? How does atropine affect the ventricular rate of third-degree heart block? Transcutaneous pacing Has no effect on the rate Which of the following is typically found on an ECG with a bundle- branch block? A notched QRS complex (rabbit ears) You are evaluating an ECG tracing that shows wide QRS complexes that were produced by supraventricular activity. On MCL1 you see a QS pattern. You suspect: A right axis shift of the ECG is noted when the QRS deflection is: Left bundle-branch block Negative in lead I, negative or positive in lead II, and positive in lead III On ECG, pulseless electrical activity looks like: Which of the following is a correctable cause of PEA? You are treating a patient who is in PEA following home dialys Which of the following drugs may be indicated? is. Any electrical activity other than ventricular fibrillation or ventricular tachycardia Tension pneumothorax Sodium bicarbonate Wolff-Parkinson-White syndrome is of little clinical importance unless the patient: Is tachycardic The three characteristics of Wolff- Parkinson-White syndrome are a shoDrtePltRa winateverval, QRS widening, and a(n):